Dentists see firsthand the damage that sugar causes on dental health and are an important alliance in the movement to end food-related disease.

The World Health Organization (WHO), the American Heart Association (AHA), and the United States Department of Agriculture (USDA) already agree that there should be limits to added sugar in the human diet. 

Not surprisingly, the American Dental Association supports the new guidelines. They submitted an official response to the USDA Guidelines proposal, supporting the changes to added sugar recommendations and advocating for more sugar research.

The IRN is interested in strengthening the network of leaders in the dental community that are supporting limits on added sugar and reduction of processed foods in general. Our Advisor, Dr. Georgia Rogers, has compiled a list of resources that can be used when discussing sugar consumption with other healthcare providers. Her tips are:

Expect to face resistance. 

Sugar has become ingrained in our culture as a “necessary” and expected component of many foods, especially for palatability after removing fat from processed food.  

Resistance to reducing sugar may also be due to sugar’s addictiveness. Reducing sugar produces characteristics of craving and withdrawal due to altered and persistent chemical changes in the brain's reward center. 

Further, the political influence of the sugar industry is pervasive, just like the tobacco industry. They have influenced professional organizations and the critical decision-makers within federal and state legislatures and agencies.  

Be prepared with facts.

74% of packaged foods sold in supermarkets now contain added sugar.

Children age 9 to 18 have the highest sugar intake – about 17% of their daily calories are from added sugar.  Almost half of the added sugar in the diets of Americans over age 2 comes from beverages such as soda and fruit drinks, sports or energy drinks, and coffee or tea.  The next third comes from sweets, snacks and grains such as crackers, bread and cereal.  Sugar is now found in foods that many consider healthy, like protein bars, yogurt and pasta sauce.  Condiments like ketchup or salad dressing can also add a few extra teaspoons of sugar to your diet each day.  

Nearly one-quarter (23%) of children aged 2-5, half (50%) of children 12-15, and two thirds (67%) of adolescents aged 16-19 suffer from tooth decay. Tooth decay is twice as common among poor or near-poor kindergarten aged children. Untreated dental disease adversely impacts children’s ability to pay attention in school, eat nutritious food, and interact with their peers.

Tooth decay is the most common reason that soldiers are dentally nondeployable, and the root cause of the majority of dental emergencies during deployment.

Dental caries is primarily a diet-dependent disease, and develops when normal oral flora that produce lactic acid by metabolizing simple carbohydrates grow out of balance. The more frequently cariogenic substances are consumed, the greater the likelihood that caries will develop. Eating or drinking meals, snacks or beverages more than 5 times a day significantly increases a child’s risk for tooth decay.  

Free sugar intake has a log linear relationship with caries prevalence at the population level.  

Sugar intake in excess of 5% of daily calories significantly increases caries experience. Reducing intake to 3% or less of daily calories can provide additional benefits in caries prevention. 

Understand the systemic effects of excess sugar consumption.

We're all in this together. Dentists, pediatric primary care, general practitioners, internists, cardiologists, endocrinologists, school nurses, WIC, and Head Start should all add screening for excessive sugar consumption and counseling on sugar reduction to the preventive services that they provide, because of sugar’s systemic health effects.

Excessive sugar intake (especially fructose) has been shown to cause dyslipidemia and metabolic dysfunction in ways unrelated to calories or effects on weight. 

Hepatic metabolism of dietary fructose results in de novo lipogenesis and increased uric acid levels.  

Clinical trials have shown a dose-dependent increase in uric acid, triglycerides, and LDL cholesterol after just two weeks of high-fructose corn syrup intake (none vs. 10%, 17.5% or 25% of energy requirements). 

Limiting sugar intake to less than 10% of total energy intake was shown to increase HDL over time. 

Dietary restriction of added fructose has shown reductions in metabolic indicators such as diastolic blood pressure, lactate levels, triglyceride, and LDL-cholesterol.  Glucose tolerance and hyperinsulinemia also improved. 

Sugar and Obesity

One daily serving increment of sugar-sweetened beverages was associated with an increase in BMI in children and weight gain in adults over the course of one year. Among adults with no dietary restriction, increased intake of dietary sugar was associated with an increase in weight, and reduced intake of dietary sugars was associated with a decrease in body weight. 

Sugar and Nonalcoholic Fatty Liver Disease (NAFLD)

Nearly all added sugars contain significant amounts of fructose, the sugar that makes fruit taste sweet.  Unlike other sugar, fructose is processed in the liver, just like alcohol.  Getting frequent, high doses of fructose throughout the day, without fiber to slow down its absorption, delivers more fructose to our liver than it was designed to handle.  This can lead to fatty liver disease, scarring, and, in one fourth of patients, cirrhosis, which can cause death.  Fatty liver disease also drives insulin resistance and metabolic syndrome. 

Sugar and Diabetes

People who drink one to two sugar-sweetened beverages per day have a 29 percent higher risk of developing type 2 diabetes, compared to people who drink less than one per month. This is true for fruit juice as well as soda. A longitudinal study of added sugar intake looking at 175 countries showed that as sugar intake increased by 150 calories per day (about one sugary drink), the prevalence of diabetes increased 11-fold. 

Sugar and Coronary Heart Disease (CHD)

Drinking just one 12-oz can of soda per day can increase your risk of dying from heart disease by nearly one-third.  A longitudinal study that examined sugar consumption and risk for cardiovascular disease mortality found that those who consumed more than 25% of their daily calories from added sugar faced almost three times greater risk of death from cardiovascular disease than those who consumed less than 10%. Drinking just one 12-oz can of soda per day can increase your risk of dying from heart disease by 16%. 

Know the limit.

The American Heart Association recommends daily limits of about 150 calories (38 grams or 9 teaspoons) of added sugar for men and 100 calories (about 25 grams or 6 teaspoons) for women.

The World Health Organization recommends reducing the intake of free sugars to less than 10% of total energy intake to prevent obesity, and reduce total health care costs, and to less than 5% of total energy intake in order to prevent dental caries.  This is based on the fact that the negative health effects of dental caries are cumulative, and even a small reduction of risk in childhood is of significance in later life.  

The new USDA Dietary Guidelines for Americans recommends a limit for added sugars of no more than 10% of daily calorie intake. If a child eats 1500 calories a day, that’s no more than 150 calories from sugar, or about 9 teaspoons of sugar.

Additional Resources

Sugar Science

Food Politics

Sugar is Killing Us

Sugar: Hiding in Plain Sight

One Sweet App (Canada) - A sugar tracker that tells you how much sugar is in your food, so you can count how many teaspoons of sugar you actually eat.  Free sugar is all types of added sugar, including juices, purees, concentrates, honey and all syrups. The stuff that’s now in 74% of our packaged foods, but that our nutrition label does NOT explain.

February is National Children's Dental Health Month

We'd like to thank Dr. Georgia Rogers for offering these phenomenal tips for working together to reduce sugar intake. If you're making a difference in the dental community or beyond, please contact us and share your ideas with regard to these important issues. Any links to research and exemplary programs (linking diet and dental health) are also appreciated.

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  • commented 2016-03-21 12:33:18 -0700
    There is solid evidence that added Fructose is a major metabolic disaster in cases of over-consumption. Every health professional should understand to the sugar sweetened beverages and sports drinks not only decay teeth-they make people sick! Fatty liver, abdominal obesity and insulin dysfunction. Time for policy changes to defeat the widespread use of “no benefit” sugars.